title: Detection of restenosis after elective percutaneous transluminal coronary angioplasty using the exercise treadmill test.
abstract: To determine the value of a 6-month exercise treadmill test for detecting restenosis after elective percutaneous transluminal coronary angioplasty (PTCA), 303 consecutive patients with successful PTCA and without a recent myocardial infarction were studied. Among the 228 patients without interval cardiac events, early repeat revascularization or contraindications to treadmill testing, 209 (92%) underwent follow-up angiography, and 200 also had a follow-up treadmill test and formed the study population. Restenosis (greater than or equal to 75% luminal diameter stenosis) occurred in 50 patients (25%). Five variables were individually associated with a higher risk of restenosis: recurrent angina (p = 0.0002), exercise-induced angina (p = 0.0001), a positive treadmill test (p = 0.008), more exercise ST deviation (p = 0.04) and a lower maximum exercise heart rate (p = 0.05). However, only exercise-induced angina (p = 0.002), recurrent angina (p = 0.01) and a positive treadmill test (p = 0.04) were independent predictors of restenosis. Using these 3 variables, patient subsets could be identified with restenosis rates ranging from 11 to 83%. The exercise treadmill test added independent information to symptom status about the risk of restenosis after elective PTCA. Nevertheless, 20% of patients with restenosis had neither recurrent angina nor exercise-induced ischemia at follow-up. For more accurate detection of restenosis, the exercise treadmill test must be supplemented by a more definitive test.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
authors.forename: J R
authors.initials: JR
authors.lastname: Bengtson
authors.forename: D B
authors.initials: DB
authors.lastname: Mark
authors.forename: M B
authors.initials: MB
authors.lastname: Honan
authors.forename: D S
authors.initials: DS
authors.lastname: Rendall
authors.forename: T
authors.initials: T
authors.lastname: Hinohara
authors.forename: R S
authors.initials: RS
authors.lastname: Stack
authors.forename: M A
authors.initials: MA
authors.lastname: Hlatky
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: K L
authors.initials: KL
authors.lastname: Lee
authors.forename: D B
authors.initials: DB
authors.lastname: Pryor
mesh_terms: D000792:Angiography; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis* / Q000628:therapy; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D013997:Time Factors